Skin surveillance is a good policy to detect pending skin erosion, thereby to prevent serious complications.
Skin can suffer local ischemia owing to several mechanisms:
compression by a pocket hematoma (following CIED implantation or replacement, trauma, or spontaneous). Use of Heparin or of Anticoagulants greatly increases the risk.
Compression by the CIED or by the lead/s on the long term
Relevant body weight loss
Chronic illnesses or malignancies
Several solutions may help to prevent skin issues, particularly at CIED replacement : sub-pectoral CIED placement, or housing the CIED in a wide subcutaneous pocket avoiding tension on the skin; careful lead placement to accommodate gentle coiling in the pocket.
Some findings are absolutely abnormal, and need to be reported to the centre in charge of CIED recipients follow up:
Do not try a personal treatment for any of these findings: refer to a centre experienced in the surgical management of CIEDs-related issues.